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Having It All: Medicine and a Family

  • Rachel L. Perlman
    Affiliations
    Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI

    Ann Arbor Veterans Affairs Medical Center, Ann Arbor Healthcare System, Ann Arbor, MI
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  • Paula T. Ross
    Affiliations
    Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, MI
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  • Monica L. Lypson
    Correspondence
    Correspondence: Address to Monica L. Lypson, MD, MHPE, Department of Internal Medicine, University of Michigan, 2600 Green Rd, #150B, SPC 5791, Ann Arbor, MI 48105.
    Affiliations
    Departments of Internal Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI

    Ann Arbor Veterans Affairs Medical Center, Ann Arbor Healthcare System, Ann Arbor, MI
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      All happy families are alike; each unhappy family is unhappy in its own way.– Leo Tolstoy, Anna Karenina
      Although the institution of marriage has changed over the past century, having a family remains vitally important. Similarly, the face of medicine has changed over the past several decades and these demographic changes have been accompanied by changes in expectations. Although contemporary physicians readily acknowledge the importance of having both a career and a family, this is not necessarily consistent with older medical traditions in which physicians were expected to sacrifice family life for medicine.
      As physicians, mentors, and investigators in academic medicine, we see medical students, resident physicians, and colleagues struggle to achieve fulfillment both at home and at work. Students and younger physicians are interested in how more senior physicians navigate the challenges of marriage, family, and career. Work-life balance and child care may have once been trivialized as “women’s issues.” However, currently men and women alike want to ensure that they devote time and energy to parenting—often at the same time that they are developing careers.
      • Puddester D.G.
      Staying human in the medical family: the unique role of doctor-parents.
      Many physicians are, at least at some point during the continuum of their medical career, interested in gaining a better insight into their relationships and developing strategies for maintaining a balance between home and medicine.
      At the University of Michigan, medical students are able to choose an elective examining “medical marriages.” This elective provides students with first-hand accounts of how their attending physicians—their teachers and mentors in medicine—manage their own work-life balance and addresses concerns about balancing family and career that extend beyond graduation. Although this is not typically addressed in the formal medical school curriculum, trainees and physicians are often interested in how they will navigate relationships, marriages, and families while pursuing a career. We see evidence of this concern in medical students when they organize panel lunchtime discussions as well as in our colleagues when they attend grand rounds on this topic. The AAMC Reporter
      • Anderson J.
      Mutual support, shared values key to success in medical marriages.
      recently dedicated an article to highlighting perspectives of physicians managing careers and families.
      Although medical marriages experience many of the same challenges of all relationships, there may be both unique stressors and protective factors. In a landmark study of 1248 graduates (1944-1960) from Johns Hopkins University Medical School, the mean age of first marriage was 26 years, the mean age at divorce was 42 years, and the incidence rate of divorce was 29% by 30 years after marriage.
      • Rollman B.L.
      • Mead L.A.
      • Wang N.Y.
      • Klang M.J.
      Medical speciality and the incidence of divorce.
      Although dated, this study also identified several key risk factors for divorce in these physicians, including marrying before graduation from medical school, difficulty with anger management, and less perceived closeness to one’s own parents. Contemporary physicians are more likely to marry and less likely to divorce than nonphysicians (Figure).

      US Census Bureau, America’s families and living arrangements. http://census.gov/population/www/socdemo/hh-fam/cps2010.html. Accessed April 13, 2015.

      Physician data: From the Association of American Medical Colleges, Diversity in the physician workforce facts & figures. http://www.ohiopa.com/aws/OAPA/asset_manager/get_file/81049?ver=381. Accessed October 14, 2013.

      There may be a modern trend to perceive formal marriage as a luxury or a status item, with better educated and wealthier individuals more likely to marry.
      • Fry R.E.
      The Reversal of the College Marriage Gap.
      Marriage as a construct may also be an archaic simplification of contemporary relationships, underrepresenting long-term cohabitation and same-sex relationships. Although in our research
      • Perlman R.L.
      • Ross P.T.
      • Lypson M.L.
      Understanding the medical marriage: physicians and their partners share strategies for success.
      we define medical marriage as a long-term relationship in which at least one partner is a physician, it is unclear how the demographic characteristics of physicians’ intimate relationships are captured. In our review of the literature, we noted that legal marriage among physicians is most likely to occur around graduation from medical school. Physicians’ older age at the time of first marriage, advanced education, and higher-than-average income all help provide the resources and resilience to navigate some of the complications of balancing home and career.
      Figure thumbnail gr1
      FigureComparison of marital status: US population and physicians.
      Medical marriages have certain benefits, and individuals in dual-physician couples have reported increased levels of marital satisfaction and intimacy because their partner understands the unique stressors in their career. This understanding can lead to more equal splitting of household duties and childcare. In addition, physicians have much less financial hardship than does the general US population. However, medical marriages can also suffer as a result of insufficient time with partner owing to fatigue and demanding workloads. Many physicians consider being “overworked” as normative; fear of compromising one’s career can lead to putting medicine before marriage and family.
      • Smith C.
      • Boulger J.
      • Beattie K.
      Exploring the dual-physician marriage.
      In single-physician couples, number of minutes spent awake with the physician partner per day and number of nights the physician partner is on call per week also influenced the domestic partner relationship satisfaction.
      • Shanafelt T.
      • Boone S.L.
      • Dyrbye L.
      • et al.
      The medical marriage: a national survey of the spouses/partners of US physicians.
      Career demands can vary with medical specialty, and specialty choice may be a risk factor for divorce. In particular, surgeons and psychiatrists were found to have a higher risk of divorce than did other physicians.
      • Rollman B.L.
      • Mead L.A.
      • Wang N.Y.
      • Klang M.J.
      Medical speciality and the incidence of divorce.
      A 2010 study of surgeons found higher rates of career conflict in surgeons married or partnered to physicians than in surgeons married or partnered to working nonphysicians. Interestingly, this conflict was higher in dual-surgeon partnerships than in surgeons partnered with nonsurgeon physicians.
      • Dyrbye L.N.
      • Shanafelt T.D.
      • Balch C.M.
      • Satele D.
      • Freischlag J.
      Physicians married or partnered to physicians: a comparative study in the American College of Surgeons.
      Another study of 167 surgeons (current residents and program alumni) over a 30-year time span suggested a trend of increased rate of childbearing during residency.
      • Smith C.
      • Galante J.M.
      • Pierce J.L.
      • Scherer L.A.
      The surgical residency baby boom: changing patterns of childbearing during residency over a 30-year span.
      Because each couple has a different dynamic, it is difficult to understand what this risk means to an individual couple.
      Our own research, based on semistructured interviews with 25 individuals in medical marriages, identifies several relationship “best practices,” including making the relationship a priority by working together to create daily routines, focusing on enhancing friendship and intimacy, and recognizing and addressing threats to the relationship.
      • Fry R.E.
      The Reversal of the College Marriage Gap.
      In addition to being willing to share their experiences, we found that physicians and their domestic partners are interested in having the opportunity to reflect on how they personally balance medicine with having a family.
      Medical training has changed since the turn of the 21st century. Restrictions on resident duty hours has shifted the amount of time that training physicians can spend in the hospital. These restrictions were based on concerns about patient safety rather than on a desire to promote physician wellness; thus, it is unclear whether restricted work hours help physicians achieve increased work-life balance. Contemporary literature does not provide young physicians with enough information about how other physicians manage having a career and family, and more research is certainly needed. Acknowledging the importance of work-life balance and personal fulfillment can be an important part of physician wellness. Despite the protective factors noted above, physicians must consciously commit to making their intimate relationships a priority. Losing ourselves in work is a disservice to both our families and our patients, because it is unsustainable for physicians who also desire to actively engage with a spouse or raise a family.

      Supplemental Online Material

      References

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      1. US Census Bureau, America’s families and living arrangements. http://census.gov/population/www/socdemo/hh-fam/cps2010.html. Accessed April 13, 2015.

      2. Physician data: From the Association of American Medical Colleges, Diversity in the physician workforce facts & figures. http://www.ohiopa.com/aws/OAPA/asset_manager/get_file/81049?ver=381. Accessed October 14, 2013.

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